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Science, Research, APA Style, and Assessing Treatments for Children with Autism

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Title: Science, Research, APA Style, and Assessing Treatments for Children with Autism


1
Science, Research, APA Style, and Assessing
Treatments for Children with Autism
  • Ps553
  • Applied Behavior Analysis Programs
  • Caldwell College

2
It All Begins with Knowledge
  • Knowledge is information about how things work
  • Information is only useful if it is accurate
    (valid)
  • Unfortunately, lots of knowledge sources have
    errors and subjective biases
  • How do we know what knowledge (information) is
    accurate?

3
Science
  • Is nothing more than a certain way to gather
    knowledge
  • Strives to minimize subjective bias and maximize
    accuracy
  • Uses objective, systematic, and direct
    observation of phenomena being studied
  • Likely to be most accurate source of knowledge
    for how things work in the world

4
Science and Assessing Effective Treatment
  • Science provides certain criteria to decide what
    information is (and is not) valid (accurate)
  • Actually, validity of information is along a
    continuum (from baloney all the way to fact)
  • Ultimate goal for autism treatment to identify
    what maximally benefits the child in need of
    intervention (and what doesnt work or may even
    harm the child!)

5
Some Terms
  • MEASUREMENT to quantify the characteristics of
    what (or whom) youre looking at (or to label it)
  • Diagnosis is a type of measurement involving
    labeling
  • severity of a disorder on a scale of 1-10 is a
    type of measurement involving quantification
  • number of requests made by a child in an hour
    is another measurement involving quantification
  • DATA the collected measurements of what youre
    examining
  • These provide evidence about how good our
    information is

6
Some Terms
  • VARIABLE anything that can be measured and that
    can change in value (what you are investigating)
  • DEPENDENT VARIABLE the part of the childs
    behavior you are measuring (outcome)
  • INDEPENDENT VARIABLE (types of intervention)
    how you are teaching the child

7
Some Terms
  • HYPOTHESIS a statement predicting how one
    variable will be related to, or affect, another
    variable
  • It is not really an educated guess but a well
    informed prediction based on past evidence
  • THEORY a statement explaining why a
    relationship exists between two variables
  • What makes a theory a good one or a bad one?
  • Shall we talk about Bettelheims Refrigerator
    Mother theory?

8
Some Terms
  • OPERATIONAL DEFINITION an objective definition
    of a variable (everyone can measure what you are
    measuring)
  • INTEROBSERVER AGREEMENT (IOA) extent to which
    observers agree on what they are observing
  • IOA will be high ONLY when the variables have
    been defined so that everyone understands what is
    being studied

9
Some Terms
  • FUNCTIONAL RELATIONSHIP degree to which the
    independent variable affects the dependent
    variable (and can you isolate this effect!!)
  • Main focus in research in autism treatment is to
    determine functional relationship between
    treatment X and behavior Y
  • (Does the treatment benefit the child? AND Can we
    conclude that it was NOT something else that
    benefited the child?)

10
Research Search for Answers!
  • How can we possibly answer those last two
    questions? (Does the treatment benefit the child?
    AND Can we conclude that it was NOT something
    else that benefited the child?)
  • Need to investigate functional relationships
    using particular, agreed upon investigation
    techniques called RESEARCH

11
Research Techniques
  • POOR RESEARCH TECHNIQUES COMMON SENSE,
    INTUITION, HUNCHES too many people use these as
    the final answer about how the world works (are
    MOST susceptible to errors and biases) also
    called street smarts
  • Perfectly fine to use these to come up with
    hypotheses and theories to test out!
  • Hmm, it seems that some kids first show signs of
    autism after vaccinations, so maybe

12
Research Techniques
  • BETTER RESEARCH INFORMATION FROM AUTHORITIES a
    better way to gain information
  • but is only as good as the authoritys
    credentials, expertise, and objectivity) also
    called book smarts
  • See what other experts of equal credentials also
    say about the topic youre investigating
  • we should always check the credentials of anyone
    claiming to be an expert on a topic
  • See the policy on autism treatment from the
    experts in Freemans (2003) book
  • Does an M.D. make you an automatic expert?

13
Research Techniques
  • BEST EXPERIMENTATION best way to gain
    information about functional relationships
    because you can isolate effects of particular
    variables under objective conditions
  • Majority of us are CONSUMERS of research findings
    generated by experiments. So?
  • So at worst we should be able to understand the
    basics at best, we should be able to conduct our
    own experiments

14
Causation vs. Correlation
  • CORRELATION two variables seem to change in a
    regular fashion with one another
  • Big Problem WAY too many people infer CAUSALITY
    from this kind of relationship when we dont
    really know, and they then act on it
  • AUTISM AND MMR VACCINES?

15
Causation vs. Correlation
  • CAUSATION when evidence collected shows us that
    when one variable alone changes, the second
    variable also changes as a result of the first
    variable!
  • Using an EXPERIMENT is what allows us to make
    such inferences of CAUSALITY
  • FACILITATED COMMUNICATION?

16
Experimental Designs
  • To reiterate, goal is to determine functional
    relationships (for this class how does a
    particular treatment affect a child?)
  • To do this, need to rule out effects of other
    variables you are not studying (called extraneous
    variables)
  • you need to CONTROL FOR the other extraneous
    variables by holding them as CONSTANTS while
    varying the treatment (independent variable)

17
Experimental Designs
  • One way to do this is to observe a single person,
    or a group of persons, under one condition
    (treatment) and then another (control
    condition) WITHOUT LETTING ANY OTHER VARIABLES
    CHANGE! Why?
  • Another way to do this is to get two or more
    groups of people who ARE THE SAME, and then apply
    the treatment to one group (treatment group)
    but not the other (control group) WITHOUT
    LETTING ANY OTHER VARIABLES CHANGE! Why?

18
Ethical Issues in Experimental Designs
  • Part of the reason why things get so confused in
    research for therapies is that the people we are
    studying are entitled to effective therapy ABOVE
    AND BEYOND WHAT VALUE CONTROLLED RESEARCH MIGHT
    PROVIDE US
  • That is, the person comes first, the research
    findings come second

19
Ethical Issues in Experimental Designs
  • This has led to some compromises in research
    designs that make them a bit less than optimal,
    but still good quality
  • But, we can still draw inferences about
    functional relationships in experiments that are
    not quite optimal but have been REPLICATED
  • The more frequently we see a functional
    relationship demonstrated, the more sure we are
    that it is a VALID relationship

20
Reading (and Writing) About Research Studies
  • Is this fun? Not usually but we can be duped by
    others if we dont know the research!!!
  • Peer-reviewed journals contain the most VALID
    research findings (beware of pseudo-scientific
    journals!)
  • Studies are written up in APA style which is an
    agreed upon way to present research findings
    (from American Psychological Association)
  • The following tips apply when reading an article

21
Types of APA Papers
  • LITERATURE REVIEW ARTICLE (ARGUMENTATIVE PAPER)
    less common
  • Involves reviewing and summarizing past research
    and drawing some kind of conclusion about what
    the research has shown to this point in time
  • Also usually makes suggestions for additional
    studies that need to be conducted to answer
    questions about the topic
  • RESEARCH STUDY ARTICLE more common
  • Involves presenting original research study and
    its findings

22
APA Style Parts of Research Study
  • ABSTRACT this summarizes
  • what purpose the study had
  • how it was conducted
  • what the findings were
  • and what the implications of these finding are
  • Its what you read when you search an article on
    PsychInfo databases
  • Its like the Readers Digest condensed version
    of the entire research report

23
APA Style Parts of Research Study
  • INTRODUCTION this section has a few important
    parts
  • It defines the topic of the research report (the
    WHAT)
  • It then tells the reader what other earlier
    researchers have already learned about this topic
    (called a literature review) and how they
    conducted their studies (the BACKGROUND)
  • Lastly, it tells the reader what the purpose is
    of the research conducted by the author of the
    paper (the PURPOSE)

24
APA Style Parts of Research Study
  • METHOD this section has many sub-parts
  • PARTICIPANTS (SUBJECTS) - provides relevant
    information about who we studied (the WHO)
  • SETTING / MATERIALS gives information about
    where the study was conducted and with what
    materials
  • PROCEDURE how the study was conducted (in great
    detail!). Also includes description of the
    VARIABLES studied and what the hypothesized
    functional relationship is expected to be.

25
APA Style Parts of Research Study
  • RESULTS
  • presents the data AND what conclusions we can
    draw from the data
  • Tells the reader whether the study turned out as
    was hypothesized
  • Studies with large groups of participants will
    often have STATISTICS which tell the reader how
    confident we can be that the results were not a
    fluke occurrence (SIGNIFICANT NOT LIKELY DUE
    TO CHANCE)
  • Also refers to graphs or tables that depict the
    data

26
APA Style Parts of Research Study
  • DISCUSSION
  • Explains WHY the data turned out as they did
    (presents THEORY underlying the effect seen)
  • Compares the findings of the study to past
    studies did they agree with or disagree with
    past studies? Did the new study add anything to
    what we already knew?
  • Is it possible that other causes not identified
    by the researcher (called CONFOUNDS) might have
    led to the findings?
  • What future research questions do we still need
    to investigate?

27
Soof course everyone uses scientifically
validated treatment, right? Not if
  • ITS EXPENSIVE
  • Because governments, school districts, and
    insurance companies need to remain fiscally
    responsible, they may be hesitant to fund
    expensive treatments EVEN IF MEDICALLY NECESSARY
  • Sad to say, but theres some evidence that this
    is a major problem in autism treatment

28
Soof course everyone uses scientifically
validated treatment, right? Not if
  • IT REQUIRES A GREAT DEAL OF TRAINING
  • People have careers invested in particular
    intervention techniques
  • Not fun to have to go back for training in new
    treatments!
  • Easier to just use what you already know (even if
    it doesnt work well!)

29
Soof course everyone uses scientifically
validated treatment, right? Not if
  • IT DISAGREES WITH A WORLD VIEW
  • See Autism National Committee (www.autcom.org)
  • Many folks are anti-science and feel that we
    must trust our gut, feel our inner child, get
    back to a simpler mind-set, become noble
    savages, connect with one another, see reward
    use as manipulation, etc.
  • This is a good example of how SUBJECTIVE BIASES
    may affect policy

30
Soof course everyone uses scientifically
validated treatment, right? Not if
  • YOUVE INVESTED A GREAT DEAL IN ANOTHER THERAPY
  • Certain states, school districts, and agencies
    have put into place huge amounts of resources so
    they are hesitant to switch

31
Soof course everyone uses scientifically
validated treatment, right? Not if
  • ITS COMPLICATED TO UNDERSTAND
  • We tend to feel uncomfortable when we dont
    understand something, even if it is the most
    effective
  • We tend to embrace simple explanations, even if
    these are not shown to be effective
  • Goal of advocates and researchers is to make
    validated treatments more understandable

32
Soof course everyone uses scientifically
validated treatment, right? Not if
  • AUTHORITIES PRESENT ONLY A BIASED SET OF EVIDENCE
  • If policy makers do not present a true picture of
    all the research that has been conducted, then
    POLICY DECISIONS will be based on inaccurate
    claims!
  • Compare the British Columbia Office of Health
    Technology Assessments report on autism
    treatment to the one by the New York State
    Department of Health

33
Soof course everyone uses scientifically
validated treatment, right? Not if
  • YOU CAN MAKE MONEY OFF PEOPLES TRUST,
    VULNERABILITY, OR LACK OF KNOWLEDGE
  • This is an ugly part of our world!
  • These unethical individuals often cloak
    themselves as scientists to appear legitimate
  • They use fancy sounding words and present bogus
    research findings
  • They may even publish bogus journals to convince
    people they are legitimate (more)

34
Some great examples of PSEUDOSCIENCE Autism
Treatments
  • The ADAM Technology
  • http//www.galaxywave.com/
  • Psychoanalysis http//www.skepdic.com/psychoan.ht
    ml
  • Facilitated communication http//www.skepdic.com
    /facilcom.html
  • Cranial Massage
  • http//www.quackwatch.org/01QuackeryRelatedTopics/
    cranial.html

35
The many Choices for Autism Treatments
  • Grouping in the good with the bad and the
    unknown
  • http//w02-0211.web.dircon.net/pubs/pubscat/docs/a
    pproach.pdf

36
Science vs. Pseudoscience Assessing Effective
Treatment
  • Now we know that science provides certain
    criteria to decide what information is, and is
    not, valid (accurate)
  • Certain characteristics are seen in
    PSEUDOSCIENTIFIC treatments that are NOT
    scientifically validated
  • How do we recognize them? Learn to be a skeptic
    (see next)

37
Becoming a SKEPTIC
  • The word SKEPTIC has a lot of negative
    connotations
  • Many people think it means rejects everything,
    non-believing, anti-feelings, cold, cranky etc.
  • It actually means SHOW ME THE MONEY!
  • It means weigh the evidence
  • It means recognize the baloney
  • It means present what really works

38
How do I (as a skeptic) evaluate treatment
claims?Pseudoscientific Therapies Some Warning
Signsoriginally printed in Science in Autism
Treatment, Spring 1999.http//www.asatonline.org/
about_autism/faq.html,,
  • High "success" claimed without valid supporting
    evidence
  • Rapid effects promised
  • Therapy said to be effective for many symptoms or
    disorders without evidence that you can
    generalize these effects

39
How do I (as a skeptic) evaluate treatment
claims?Pseudoscientific Therapies Some Warning
Signsoriginally printed in Science in Autism
Treatment, Spring 1999.http//www.asatonline.org/
about_autism/faq.html
  • Theory behind the therapy contradicts objective
    knowledge (and, sometimes, common sense)
  • Therapy said to be easy to administer, requiring
    little training or expertise

40
How do I Evaluate Treatment Claims?
  • Other scientifically validated treatments are
    said to be unnecessary, inferior, or harmful.
  • Promoters of the therapy work outside their area
    of expertise.
  • Only testimonials, anecdotes, or personal
    accounts are offered in support of claims about
    the therapy's effectiveness. Little or no
    objective evidence is provided.
  • Catchy, emotionally appealing slogans are used in
    marketing the therapy.
  • Belief and faith are said to be necessary for the
    therapy to "work."

41
How do I Evaluate Treatment Claims?
  • Skepticism and critical evaluation are said to
    make the therapy's effects evaporate.
  • Promoters resist objective evaluation and
    scrutiny of the therapy by others.
  • Negative findings from scientific studies are
    ignored or dismissed.
  • Critics and scientific investigators are often
    met with hostility, and are accused of
    persecuting the promoters, being "close-minded,"
    or having some ulterior motive for "debunking"
    the therapy.

42
MoreHow do I Evaluate Treatment Claims?
  • Source American Academy of Pediatrics Committee
    on Children with Disabilities http//pediatrics.aa
    ppublications.org/cgi/reprint/107/5/e85.pdf
  • Treatment is based on overly simplified
    scientific theories (e. g., certain sounds can
    re-organize the brain)
  • Treatment fails to identify specific treatment
    objectives or target behaviors
  • Treatments are stated to have no adverse effects
    without supporting evidence thus, proponents
    deny the need to conduct controlled studies
  • (This contradicts ALL ethical codes, which
    require First, do no harm!)

43
STOP
44
Sensory Integration Therapy
  • Sensory Integration (SI) therapy is a
    sensory-motor treatment developed by Dr. A. Jean
    Ayres.
  • Proponents theorize that sensory integration is
    an innate neurobiological process
    (Hatch-Rasmussen, 1995), and that children with
    autism and other developmental delays experience
    dysfunction in which sensory input is not
    integrated or organized appropriately by the
    brain.

45
Evaluating Sensory Integration Therapy
  • Current research does not support SI as an
    effective treatment for children with autism,
    developmental delays or mental retardation
  • SI has not been shown to be responsible for
    positive change in a child's behaviors or skills.
  • In at least one study, SI was shown to actually
    increase self-injurious behaviors.
  • Association for Science in Autism Treatment

46
Evaluating Sensory Integration Therapy
  • "Though Sensory Integration Therapy does not
    appear to enhance language, control disruptive
    behaviors, or otherwise reduce autistic
    behaviors, it may offer enjoyable, healthy
    physical activity (Smith, 1996).
  • Professionals considering SI interventions
    should portray the intervention as experimental,
    and disclose this status to key decision makers
    influencing the child's intervention.
  • Association for Science in Autism Treatment

47
Auditory Integration Training
  • Developed in 1960s by French physician Guy Berard
  • AIT is based on unproven theory that symptoms in
    autism are caused by auditory perception defects
    that distort sound or produce auditory
    hypersensitivity (hyperacusis).
  • Treatment consists of identification of sound
    distortion or hypersensitivity followed by twice
    daily sessions for 2 weeks in which computer
    modified music determined to be optimum for the
    patient is played through a device called the
    Audiokinetron.

48
Concerns
  • Audiokinetron may potentially be unsafe,
    delivering levels of sound to the eardrum that
    may be harmful to hearing.
  • AIT devices do not have FDA approval for treating
    autism or any other medical problem.
  • The FDA has banned the importation of the
    Electric Ear and any other AIT device made by
    Tomatis International, of Paris, France.

49
Evaluating Auditory Integration Therapy
  • No well-designed scientific studies demonstrate
    that AIT is useful (in any form including
    Tomatis) therefore AIT is not recommended for
    children with autism.
  • The American Academy of Pediatrics
  • The American Academy of Audiology

50
Evaluating Auditory Integration Therapy
  • AIT is not yet objectively substantiated as
    effective subject to the rigors of good science.
  • Professionals considering AIT should portray the
    method as experimental, and should disclose this
    status to key decision makers influencing the
    child's intervention.
  • Association for Science in Autism Treatment

51
Evaluating Auditory Integration Therapy
  • A randomized controlled trial with an adequate
    sample size found no differences in children
    receiving auditory integration training as
    compared with those listening to the same music
    which had not been modified.
  • A recent controlled study found no benefit of AIT
    and poorer scores on social and adaptive and
    expressive language scores after AIT.
  • Because of the lack of demonstrated efficacy and
    the expense of the intervention, it is
    recommended that auditory integration training
    not be used as an intervention for young children
    with autism.
  • New York State Department of Health Early
    Intervention Guidelines

52
Claims of Evidence for AIT
  • Two studies are offered by AIT proponents which
    do not meet the rigors of scientifically valid
    research
  • Gilmor, T. M. (1999). The Efficacy of the Tomatis
    method for Children with Learning and
    Communication Disorders, International Journal of
    Listening, 13, 12.
  • This journal does not fit the definition of peer
    reviewed (review by published scientists)
  • Conclusions in the paper are based on the
    technique of meta-analysis of past studies
    (conclusions drawn from selected pieces of many
    studies) not empirically validated research.
  • Credibility of Journals mother organization
    (International Listening Association) is
    questionable. Web page contains quotes from
    Artists, Writers, and Rock Stars
  • "Listen, learn, read from Deep Purple

53
Claims of Evidence for AIT
  • Second study offered by AIT proponents
  • Neysmith-Roy,  J.  M. (2001). The Tomatis Method
    with severely autistic boys Individual case
    studies of behavioral changes, South African
    Journal of Psychology, 31.
  • Case study does not qualify as empirically
    validated research. It is a description of
    somebodys characteristics but has no controlled
    assessment of treatment variables.

54
Traditional Speech Language Therapies
  • Non-behavioral speech and language therapists
    have developed many different treatments (e.g.,
    PROMPT) most of which are aimed at stimulating
    childrens natural interest and ability in
    learning language.
  • The treatments usually take place in one-to-one
    sessions held from ½ to 3 hrs per week.

55
Evidence of Traditional Speech Language
Therapies
  • No scientific studies have evaluated whether any
    form of speech and language therapy, other than
    behavior analysis, helps children with autism.
  • There have been no studies to evaluate the
    effectiveness of PROMPT therapy with children
    with autism
  • Dr. Rogers at the MIND Institute is currently
    heading up a project comparing PROMPT with other
    models of language
  • No outcome data have been produced, as of yet.

56
Evaluating Traditional Speech Language Therapies
  • By itself, speech and language therapy is
    probably not intensive enough to be very
    effective.
  • However, it may augment other interventions by
    identifying areas that need remediation or
    offering strategies for promoting the use of
    language skills in everyday settings.

57
Speech Language Therapies Using ABA
  • A variety of behavioral techniques has been shown
    to be effective for increasing and improving
    language and communication in children with
    autism (e.g., activity schedules, audio modeling,
    video modeling, PECS)
  • When teaching children with autism, speech and
    language therapy has been shown to be maximally
    effective when delivered using the principles of
    ABA

58
What is an Integrated Treatment Model?
  • (Sometimes referred to as combination model,
    comprehensive model, eclectic model, whole person
    model)
  • Using an integrated model assumes there are
    multiple effective therapies that, when combined,
    work even better than the single effective
    therapies.
  • Using an integrated model also assumes that
    proponents are using only the therapies that have
    been shown to work while ignoring the ones that
    have not.
  • But to find out which ones work, you MUST look
    for controlled studies that demonstrate
    effectiveness (use objective data, not
    testimony).
  • If this has not been done, then proponents may be
    taking away time from therapies that have been
    shown to be effective by advocating for an
    integrated model
  • There is currently NO evidence that combinations
    of therapies for autism are better than the sum
    of their parts.

59
Evaluation of Integrated Therapies
  • Eikeseth, Smith, Jahr, Eldevik (2002)
  • Compared applied behavior analysis (ABA) with an
    integrated treatment
  • ABA treatment consisted of language, social,
    academic, fine/gross motor, and self-help skills
  • Integrated treatment consisted of sensory
    integration therapy, speech therapy, and ABA
  • At a 1-year evaluation, 13 children who had
    received ABA treatment made significantly larger
    improvements than a comparison group of 12
    children who had receive intensive, integrated
    therapy.
  • On average the ABA group gained 17 points in IQ,
    13 points in language comprehension, 23 points in
    expressive language, and 11 points in adaptive
    behavior.

60
Greenspan (DIR Floortime)
  • Stanley Greenspan, MD and colleagues have
    published papers on theories of child
    development.
  • Only one relates specifically to children with
    autism others may include references to autism
    among an array of disabilities.
  • Greenspan and others have created a
    developmental approach for early intervention
    with children with disabilities (Developmental
    Individual-Difference, Relationship-Based Model)
    commonly referred to as the "Floor Time" approach
    (Greenspan, 1998).

61
Greenspan (DIR Floortime)
  • DIR/Floor Time includes interactive experiences,
    which are child-directed, in a low stimulus
    environment, ranging from two to five hours a
    day.
  • During a preschool program, DIR/Floor Time
    includes integration with typically-developing
    peers.
  • Greenspan contends that interactive play, in
    which the adult follows the child's lead, will
    encourage the child to "want" to relate to the
    outside world. (Greenspan, 1998).

62
Evaluating Greenspan therapy
  • There have been no peer-reviewed, published
    studies of Greenspan's DIR/Floor Time's
    effectiveness for children with autism.
    Professionals considering Greenspan's Floor Time
    should portray the method as without
    peer-reviewed scientific evaluation, and should
    disclose this status to key decision makers
    influencing the child's intervention.
  • Association for Science in Autism Treatment

63
Evaluating Greenspan therapy
  • There are no adequate controlled trials that
    have evaluated the efficacy of intervention
    approaches based on the DIR model for treating
    young children with autism
  • Approaches based on the DIR model can be time
    intensive for both professionals and parents and
    may take time away from other therapies that have
    been demonstrated to be effective
  • New York State Department of Health Early
    Intervention Guidelines

64
Miller Method
  • The Miller Method uses adaptive equipment,
    including platforms (that elevate the child in
    hopes of increasing eye contact), large swinging
    balls (to expand the child's reality system), and
    Swiss cheese boards (to teach motor planning, as
    well as to increase the child's understanding of
    his or her relation to environment and space.)
    (Miller, 1998).

65
Evaluation of Miller Method
  • The Miller Method may have promise, but it is
    not yet objectively substantiated as effective
    subject to the rigors of good science.
  • Professionals considering the Miller Method
    should portray the method as experimental, and
    should disclose this status to key decision
    makers influencing the child's intervention.
  • Association for Science in Autism Treatment

66
Nutritional Supplements and Megavitamin Therapy
  • Anecdotal and case reports have generated
    interest in the use of a variety of nutritional
    supplements to treat children with ASD.
  • Studies have shown mixed results
  • Some studies have been criticized for their
    methodological shortcomings and failure to
    address the issue of safety of use.

67
Elimination diets
  • The presence of allergies or food intolerance in
    children often stimulates families to explore
    unconventional diets.
  • Recent investigations failed to document a higher
    prevalence of hypersensitivity to common food
    allergens in children with autism compared with
    controls.

68
Immune Globulin therapy
  • There is some evidence for immunologic
    abnormalities in small numbers of children with
    autism including abnormalities of T cells, B
    cells, natural killer cells, and the complement
    system
  • In a study of 20 children with ASD, 10 who
    received intravenous immune globulin for a
    6-month period reportedly demonstrated
    improvements in social behavior, eye contact,
    echolalia, and speech articulation.
  • Note The investigators did not use standard
    outcome measures and did not state whether
    participants received other concurrent treatments
    during the course of the study.

69
Immune Globulin therapy
  • Two recent reports failed to demonstrate
    significant changes in behaviors associated with
    autism in 17 children who received regular
    infusions of immune globulin for a 6-month
    period.
  • There is no scientific evidence to justify the
    use of infusions of immune globulin to treat
    children with autism.

70
Secretin
  • Anecdotal reports of 3 children whose behaviors
    were seemingly helped by secretin generated much
    publicity and interest in its treatment potential
  • Recent studies, however, have failed to
    demonstrate any scientific evidence to justify
    the use of secretin infusion to treat children
    with autism.

71
Chelation Therapy
  • Some theorize that autism might be caused by
    early childhood exposure to environmental
    toxicants, particularly mercury
  • To date, there are no published studies linking
    mercury exposure to the development of autism or
    demonstrating that children with autism have had
    greater exposure to mercury than have unaffected
    children.

72
Evaluating Chelation Therapy
  • Although several chelating agents have been shown
    to accelerate mercury elimination from the body,
    there is no evidence that chelation therapy will
    improve developmental function.
  • Moreover, chelating agents can have significant
    toxicity and cause allergic reaction.
  • Chelation therapy is therefore not recommended to
    treat autism

73
Applied Behavior Analysis(Behavior Management
Intensive Behavioral Intervention)
  • Intensive, behavioral intervention early in life
    can increase the ability of the child with autism
    to acquire language and ability to learn.
  • Thirty years of research demonstrated the
    efficacy of applied behavioral methods in
    reducing inappropriate behavior and in increasing
    communication, learning, and appropriate social
    behavior. A well-designed study of a psychosocial
    intervention was carried out by Lovaas and
    colleagues (Lovaas, 1987 McEachin et al., 1993).
    Up to this point, a number of other research
    groups have provided at least a partial
    replication of the Lovaas model (see Rogers,
    1998).
  • U.S. Surgeon General David Satcher, M.D., Ph.D.

74
Applied Behavior Analysis
  • All programs educating children with autism
    should include intensive behavioral interventions
    and year-round education.
  • The US Dept. of Education and the
  • National Research Council's Report
  • 'Educating Children with Autism
  • Since intensive behavioral programs appear to be
    effective in young children with autism, it is
    recommended that principles of applied behavior
    analysis and behavioral intervention strategies
    be included as an important element of any
    intervention program.
  • NYS Department of Health Early Intervention
  • Clinical Practice Guidelines

75
References
  • American Academy of Pediatrics Committee on
    Children With Disabilities. (2001). Technical
    Report The Pediatrician's Role in the Diagnosis
    and Management of Autistic Spectrum Disorder in
    Children, Pediatrics, 107(5).
  • Fenske, E. C., Zalenski, S., Krantz, P. J.,
    McClannahan, L. E. (1985). Age of intervention
    and treatment outcome for autistic children in a
    comprehensive intervention program. Analysis and
    Intervention in Developmental Disabilities, 5,
    49-58.

76
References
  • Jacobson, J. W. (2001). Early intensive
    behavioral intervention Emergence of a
    consumer-driven service model. The Behavior
    Analyst, 23(2), 149-171.
  • McEachin, J. J, Smith, T., Lovaas, O. I.
    (1993). Long term outcome for children with
    autism who received early intensive behavioral
    treatment. American Journal on Mental
    Retardation, 97(4), 359-372.
  • Smith, T. (1993). Autism. In T. Giles (Ed.),
    Handbook of effective psychotherapy (pp.
    107-133). NY Plenum Press.

77
ABA Resources
  • Books
  • Handleman, J. S., Harris, S. L. (2001).
    Preschool education programs for children with
    autism. Austin, TX Pro-Ed.
  • Harris, S. L., Weiss, M. J., (1998). Right from
    the start Behavioral intervention for young
    children with autism. Bethesda, MD Woodbine
    House.
  • McClannahan, L. E., Krantz, P. J. (1999).
    Activity schedules for children with autism
    Teaching independent behavior. Bethesda, MD
    Woodbine House.

78
ABA Resources
  • Books
  • Leaf, R., McEachin, J. (Eds.). (1999). A work
    in progress Behavior management strategies and a
    curriculum for intensive behavioral treatment of
    autism. New York DRL Books.
  • Lovaas, O. I. (2002). Teaching individuals with
    developmental delays Basic intervention
    techniques. Austin, TX Pro-Ed.
  • Maurice, C., Green, G., Fox, R. M. (Eds.).
    (2001). Making a difference Behavioral
    intervention for autism. Austin, TX Pro-Ed.
  • Maurice, C., Green, G., Luce, S. C. (Eds.).
    (1996). Behavioral intervention for young
    children with autism. Austin, TX Pro-Ed.

79
ABA Resources
  • Websites
  • NY State Guidelines
  • www.health.state.ny.us/nysdoh/eip/autism/autism.ht
    m
  • - Behavior Analysis Certification Board
  • www.bacb.com
  • General Information about Autism
  • www.asatonline.org/autism_info.html
  • www.behavior.org/autism/
  • pediatrics.aappublications.org/cgi/reprint/107/5/e
    85.pdf
  • books.nap.edu/books/0309072697/html/index.html
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